Friday, June 4, 2010

In the summer of 2009, a program offering placements to nursing in northern communities was extended to allied health practitioners at University Health Network. This program, funded by the Ontario Ministry of Health, allowed clinicians to travel north for approximately four weeks to engage in education networking as well as clinical care delivery opportunities. The purpose of this program is to foster collaboration, to exchange knowledge, and to provide an enriched experience among health care practitioners. The opportunity appealed to my adventurous side and on August 24, 2009, I began my northern experience.

The bulk of my five-week placement was on Moose Factory Island located on the Moose River just south of James Bay. The island has a population of approximately 2700 individuals who are predominantly of Cree First Nation descent. The nearest town is Moosonee that is so remote that it has no road access. Travel to Moose Factory Island involves a flight or train to Moosonee followed by a boat, helicopter or car ride across the Moose River depending on the season and the stability of the ice road in winter.

My placement was based out of Weeneebayko General Hospital – a hospital that had been without an inpatient dietitian for two years. Part of the challenge with this placement was etching out how to best utilize my time and resources while I was there. Some of the responsibilities I undertook included assessing and implementing nutrition care plans with inpatient and outpatient consults, preparing community presentations on a variety of nutrition topics, and assisting in various clinics. I also had the opportunity to fly to the coastal community of Kashechewan to assess the nutritional status of women at the prenatal clinic.

The challenges were numerous and overwhelming, and my brain was stretched with the magnitude of nutritional issues that this community faced. Food insecurity, substance abuse, isolation, poverty, and the prevalence of nutritionally relevant illnesses seemed to be more the norm than the exception. In addition to these challenges, there was the education level of the clientele (many could not read English or Cree), the lack of other allied health professionals to which I had become so accustomed (e.g., speech language pathologists), my unfamiliarity with some of the foods (e.g., bannock bread), and the research into nutritional issues that I would not typically see on my general internal medicine unit in Toronto.

It was sometimes hard to know what to say to the 20 year old mother of three who told me that she could not afford to eat healthy food when four litres of milk was $13.59 and a five pound bag of potatoes was $10.69. It was difficult to remain unmoved by the elderly gentleman on hemodialysis who was too tired to cook, had no family, and for whom there were neither home care services nor home meal delivery services to provide assistance. There was also the challenge of trying to advise young mothers against feeding their babies evaporated milk and convincing them that it was nutritionally incomplete (even though it was what their mothers had done for them). Food availability did not make it any easier. If you were well accustomed to the grocery store delivery schedule, you could get the pick of the best and freshest groceries available. In-between deliveries, you would be lucky to find half-decent fresh fruits and vegetables, if available at all. One evening when I went to pick up milk, I found that the entire island was sold out until the next delivery.

Provision of dietetic services up north is unique in both the needs of the clientele and the retention of professional services. However, despite all of the challenges – maybe even because of them – I found dietitian work in the north to be truly satisfying. Overcoming the seemingly insurmountable hurdles produced a sense of achievement. Dietetics in the north is rewarding and fulfilling; I would encourage you to consider the many opportunities that abound in northern Ontario. I also encourage you to embrace every opportunity you get to immerse yourself in other cultures! Cultural competence is an ongoing process that is developed through familiarization of oneself with and in diverse cultural backgrounds. By better understanding cultural norms and mores, nutrition professionals can tailor nutrition counselling to best meet client needs. For the vast majority of my placement, I was working outside my ‘comfort zone’, and it was a great way to grow, both personally and professionally. I was grateful to be part of such a collaborative initiative that exposes health care staff to unique educational opportunities.

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Practice includes information on scientific and clinical developments and Canadian dietitians’ experiences and challenges in practice. Opinions expressed in articles are those of the authors and do not imply policy of the Association unless so stated. Articles are not peer-reviewed.